The Origins of Plague

The book takes the readers through the history of the disease, when people know there is deadly disease, but had no idea how it is caused and how it spreads. It was an era of fear, confusion, superstition, as a nameless contagion was killing people in droves. Vidya carefully navigates this history through poignant anecdotes and illuminating facts that make it an engaging read.

The story of Dr. Ignaz Semmelweis was particularly moving. He was convinced that washing hands before operations would help reduce mortality, yet he was ridiculed by his peers. His tragic end left me heartbroken. It was ironic that he was dubbed as “Saviour Mothers” after his death, when Louis Pasteur confirmed germ theory of disease.

The book also highlights a fascinating mid-19th-century American phenomenon known as the “man problem”—the crisis of public spitting. As germ theory gained traction, authorities attempted to curb the behavior, failing to realize just how deeply ingrained the habit was. Here, Krishnan masterfully exposes how patriarchy overruled rationality: rather than taking responsibility for their own habits, men blamed women’s long skirts for tracking germs into the home, conveniently ignoring the fact that it was their own sputum spreading the disease.       

The Scope of Contagion

Moving from history to the present, Krishnan paints a terrifying portrait of our current reality. While the advent of antibiotics was a triumph for humanity, their rampant misuse is fueling drug-resistance in TB bacteria, making the treatment difficult. She highlights a stark geographical divide: while TB is largely contained in the West, it remains a rampant, spreading threat across South Asia and parts of Africa.

This section is particularly alarming, leaving the reader with a sense of helplessness and frustration. Her account of a TB-stricken housing society in Mumbai, interwoven with the individual stories of patients, exposes a heartbreaking reality. Because TB is airborne, the risk of transmission is universal—anyone in public spaces is potentially exposed—yet those living and working in cramped conditions face a significantly higher probability of infection than the wealthy. It is the poor, however, who bear the brunt of the disease; even when detected, they face daunting barriers to correct treatment. Whether due to delayed diagnosis or misdiagnosis, or simple the apathy of the system. The author cites harrowing examples that will leave readers truly shaken.

The Economic and Moral Failure

The author then transitions to the challenges of eradication and patient care. As you read through this section, your initial sense of fear and helplessness gives way to anger and frustration. It is a maddening paradox: TB is a known, airborne, and curable pathogen, yet there is no concrete action. The Indian government’s target to eradicate TB by 2025 has come and gone; we are now well past that deadline, yet we still lack the necessary vaccines and medicines to treat patients suffering from drug-resistant TB. So much for the fanfare of political announcements.

The irony is stark: India, the ‘pharmacy of the world,’ denies its own citizens access to life-saving drugs manufactured on their soil. Global pharma giants exploit India’s lower production costs to manufacture these drugs, only to export them globally at massive markups—leaving the most vulnerable without the treatment they need. Krishnan critically examines this patent system, exposing a sharp contradiction: while patents are intended to incentivize innovation, they often serve to render essential medication unaffordable for the very people who need it the most. Ultimately, the government fails to leverage its power to prioritize public health over corporate interests, leaving one to ask: what is the value of being the ‘pharmacy of the world’ if the nation cannot provide life-saving medicine to its own people?

Since the book came out (2022), India has rejected the patent request of J&J for the salt of drug-resistant TB medicine (bedaquiline) in 2023 and now Indian companies are making generic drug-resistant TB medicines.